Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review
Open accessAbstract
Background: Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. Methods: A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English‐language studies since 1993. Inclusion criteria included peer‐reviewed, US‐based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. Results: The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching ( n = 4), a clinical trial educational video ( n = 2), institutional research infrastructure changes ( n = 1), a relationship building and social marketing recruitment model ( n = 1), and cultural competency training for providers ( n = 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. Conclusions: This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.
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A frequently cited reason for underrepresentation of certain minority ethnic groups in clinical trials is pervasive mistrust in the healthcare system, often attributed to historical instances of mistreatment and exploitation.
“A frequently cited reason for the underrepresentation of certain minority ethnic groups in clinical trials is a pervasive mistrust in the healthcare system. This is often attributed to historical instances of mistreatment and exploitation.”
From Enablers and barriers of clinical trial participation in adult patients from minority ethnic groups: a systematic review (2025) · cites this paper as [3]
The Introduction (page unavailable) identifies mistrust as an extensively studied barrier to minority enrollment in cancer clinical trials. It does not explicitly describe that mistrust as pervasive throughout the healthcare system or attribute it to historical mistreatment and exploitation; its references to the Tuskegee study do not establish that full claim. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMinority ethnic groups have often been underrepresented or omitted from clinical trial research.
“Historically, there has been a lack of ethnic representation in clinical trial participants; minority ethnic groups have often been underrepresented or omitted from research [3, 4].”
From Enablers and barriers of clinical trial participation in adult patients from minority ethnic groups: a systematic review (2025) · cites this paper as [3]
The Tuskegee Syphilis study and the Henrietta Lacks incident are examples of unethical and exploitative research.
“Two infamous examples of such unethical and exploitative research are often quoted: the Tuskegee Syphilis study, in which Black men were intentionally denied treatment for syphilis; and the Henrietta Lacks (HeLa) incident, where the patient’s cancer cells were provided to researchers unbeknownst to her.”
From Enablers and barriers of clinical trial participation in adult patients from minority ethnic groups: a systematic review (2025) · cites this paper as [3]
The Introduction discusses mistrust as a barrier to clinical-trial enrollment, and the References list works about the Tuskegee study. Neither passage describes Tuskegee as unethical research or addresses the denial of treatment. Searches for Henrietta Lacks and HeLa found no passage about her cells or consent. (LLM, conf=0.74)
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The reporting of race and ethnicity in cardiothoracic surgery literature
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Toward Achieving Equity in Cancer Clinical Trials
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Patients Drive Authentic Trusted Solutions for Inclusive Clinical Trials
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- Authors
- Nouvini, R., Parker, P. A., Malling, C. D., Godwin, K., & Costas‐Muñiz, R.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Memorial Sloan Kettering Cancer Center New York New York USA
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2022-09-15
- Volume
- 128
- Issue
- 21
- Pages
- 3860-3869
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- PMC
- PMC10456972
- OpenAlex
- W4295907091
- Cited by
- 56
- References
- 48
- Citations by year
- 2026: 13 · 2025: 15 · 2024: 19 · 2023: 9
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Foundation for the National Institutes of Health (P30 CA008748)
- National Institutes of Health (CA008748, P30)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Keywords
- racial and ethnic minorities, cancer clinical trials, clinical trial accrual, underrepresentation in clinical trials, patient navigation, patient coaching, cultural competence training, social marketing, Black patients, Hispanic patients
- MeSH terms
- Ethnic and Racial Minorities, Adult, Ethnicity, Female, Humans, Minority Groups, Neoplasms, Racial Groups
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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